True or False: Ten statements about STBBIs

Many people infected with an STBBI may have few or no symptoms or signs of infection, even several weeks after having unprotected sex. Therefore, screening tests remain essential to confirm that you are not infected or that any previous infections have been effectively cured. Depending on the disease, tested can be carried out on urine, blood, vaginal or anal discharge or other samples (urethra, throat, eyes and ears).

There are many risk factors and situations that justify the need for testing, even if the sexual partners have no signs or symptoms of an STBBI:

• Unprotected sex 
• Sharing equipment used for injecting or inhaling drugs 
• Tattooing or body piercing with unsterilized equipment 
• Exposure to contaminated biological fluids, including sex toys contaminated with semen or vaginal secretions 
• Discontinued use of condoms or dental dams by couples in a stable relationship 
• Pregnancy 
• Sexual relations that you or your partner have had with a new partner, several partners or a partner with an STBBI

According to the Public Health Agency of Canada, the population groups most affected by STBBIs should be tested regularly. [1] Here are the risk factors:

• Multiple partners (simultaneously or over time)
• Anonymous or casual sexual partners
• Sexual relations without the use of a barrier method
• Sexual relations with people with an STBBI
• A history of STBBIs
• Substance use (i.e., drugs, alcohol or both)
• Use of erectile dysfunction medications
• A history of intimate partner violence or sexual abuse
• Social environments (e.g., saunas, circuit parties, post-secondary institutions)

The timing of the test is an important aspect of STBBI screening. No test will be positive the day after infection. In some cases, it may take 10 days for a syphilis infection to be detected. The end of the window period during which this infection can remain undetectable can extend up to 12 weeks, as is the case for hepatitis B, hepatitis C and HIV. The window period for chlamydia and gonorrhea is shorter, at around 14 days. In the event of an initial negative result, most of these tests need to be repeated to ensure that infection can truly be ruled out. As technology evolves rapidly, these timeframes need to be reviewed regularly. [2,3]

A Pap test is not a screening test for STBBIs. It merely checks for the presence of cervical lesions caused by the human papillomavirus (HPV).

In an immunocompetent person, lifelong protection can only be obtained for infections that can be prevented by successful vaccination, such as HPV and hepatitis A or B. Chlamydia, gonorrhea and syphilis do not elicit a sufficient immune response from the body, so people can be infected repeatedly. Infection with the herpes virus lasts a lifetime. In rare cases, people undergoing effective treatment for HIV may become infected with another type of drug-resistant HIV.

Chlamydia can be effectively treated with antibiotics such as doxycycline (a tetracycline) and azithromycin (a macrolide), which block bacterial growth. However, the situation is more concerning for gonorrhea. Over the decades, the bacteria responsible have developed resistance to several antibiotics: first penicillin, then tetracyclines, macrolides and quinolones. Today, cephalosporins are among the last effective options. New resistant strains are also beginning to appear [4]. As a result, this infection is becoming increasingly difficult to treat. While awaiting new treatments, physicians use different combinations of antibiotics to try to control the infection.

Syphilis is indeed a very old sexually transmitted disease. The rate observed in Canada was very low until 2001, when it began to rise, particularly among men and more recently among heterosexual women. From 2018 to 2023, the global syphilis infection rate doubled from 6,371 cases to over 12,000. During the same period, the number of newborns with neonatal syphilis tripled. [5]

In Canada, it is a crime not to disclose, before having sex, that you have HIV, which poses a “significant risk of serious bodily harm.” The person is usually charged with aggravated sexual assault, one of the most serious offences in the Criminal Code, carrying a maximum sentence of life imprisonment and the mandatory designation of sex offender. [6]

So far, most legal proceedings have involved HIV, and virtually none concern herpes, syphilis, chlamydia or other STBBIs. You can, however, be sued in civil court, including small claims court, for failing to report an STBBI other than HIV (sections 7 and 1457 of the Civil Code).

Although it is not the most frequent source of transmission, it is entirely possible to catch an STBBI during unprotected oral sex, with or without orgasm or ejaculation. During fellatio, the risk of contracting herpes and syphilis is high, but lower for HIV, chlamydia, gonorrhea and HPV.

The risks are about the same during cunnilingus and are increased for HIV, hepatitis B and hepatitis C if there is blood in the vaginal secretions. [7]

Further reading: What is an STBBI and how is it transmitted?

The viruses and bacteria that cause STBBIs can only survive very briefly on surfaces such as a toilet seat, and it is highly unlikely that they will still be alive when the next person uses it. What’s more, contact with the germ would have to occur between the toilet seat and a very specific part of the body with an open wound. Therefore, for all intents and purposes, transmission is impossible. [8]

Washing with mild soap and water after sex is an acceptable hygiene measure but does not protect against STBBIs. However, urinating can eliminate some of the micro-organisms at the exit of the urethra (the tube through which urine is expelled), thereby preventing urinary infections. In particular, vaginal douches should be avoided as they can irritate the vaginal mucosa or push micro-organisms further into the vagina. [9]

On the contrary, according to the World Health Organization (WHO), “there is ample evidence that quality sex education produces positive health outcomes with benefits that last throughout a person’s life. Young people are more likely to delay the start of their sexual activity – and when they do have sex, to have safe sex – if they are better informed about their sexuality, sexual health and rights. [11]”

Teenagers are very exposed to sexuality through the internet and social networks. Some of the messages conveyed are true, others, patently false. Limiting themselves to this exposure does not give them all the information they need and puts them at greater risk of infection.

Read more: How to speak about sexuality with your teenagers

We offer STBBI screening with results in 24 hours or less for chlamydia, gonorrhoea, syphilis, hepatitis B, and HIV.

• To find out more about our STBBI services
• To start your online screening
  
  Book an appointment online or contact Biron Health Group’s customer service at [1 833 590-2712].